Methodologically Sound Studies
Britton et al. (2014). RCT, 110 sixth grade students at a Quaker school in Providence, Rhode Island. The authors sought to improve upon previous studies by having the control group perform a novel and exciting activity, hoping to determine if changes in the treatment group might be due to the effects of novelty. Both groups were six-week long history classes led by the same two teachers, one with extensive mindfulness experience, the other who had taken an eight-week MBSR class. The treatment group was an Asian history class in which the teacher began class every day with a silent meditation, which lasted three minutes the first class and grew to 12 minutes by the final week. The meditation consisted of breath awareness, body scans, and labeling body sensations, thoughts, and emotions. The control group was an African history class in which students, instead of meditating, the students were given time each class to construct a life-sized Egyptian sarcophagus. Students were asked to complete three measures at pretest and posttest: the Youth Self Report (YSR) to assess clinical symptoms (e.g., internalizing problems, externalizing problems, attention problems), the the State-Trait Anxiety Inventory-Child version (STAI-C) to assess positive and negative affect, and the Cognitive and Affective Mindfulness Scale (CAMS-R) to assess mindfulness things like ability to regulate attention and maintain a non-judgmental attitude toward present experience. At posttest both groups showed significant decreases in clinical symptoms and improvements in the affective measures, but the differences between the groups were not clinically significant. The treatment group did show larger improvements than the control group on measures of suicidal ideation. // Comments: “as both courses involved novel, nondidactic classroom activities, it is possible that considerable benefits in attention and affect can be produced by a wide range of engaging, experiential activities that are not limited to meditation.” “An important question that future studies should be investigating is whether mindfulness or meditation training is equally beneficial for everyone or whether some individuals may be better off with other approaches.”
Methodologically Unsound Studies
Flook et al. (2010). RCT, diverse group of 64 second/third grade general education students in Los Angeles. Half of the students were placed in a Mindful Awareness Practices (MAPs) group, while the other half were placed in a silent reading group. The MAPs group helped children to increase awareness of self, the environment, and others. Each group met for 30 minutes twice a week for eight weeks. Both teachers and parents completed a Behavior Rating Inventory of Executive Function (BRIEF) for each student at pretest and posttest. Students in the MAPs group who scored in the highest quartile at pretest (meaning they had the poorest executive functioning skills) showed significant improvement at posttest compared to their counterparts in the reading group. No meaningful difference was found between students with lower pretest scores (meaning students with higher executive functioning skills). // This study is extremely flawed. James Coyne enumerates its many problems. For starters, the study is non-blinded, and its measures are all subjective. Second, there wasn’t an active control. Given this, Coyne writes, “There’s a high likelihood of any differences in outcomes being nonspecific and not something active and distinct ingredient of mindfulness training. In any comparison with the students assigned to reading time, students assigned to mindfulness training have the benefit of any active ingredient it might have, as well as any nonspecific, placebo ingredients.” Third, the sample size is small (making the study "underpowered"). Given this, it’s not a complete surprise that “the differences that are limited to the upper quartile are [evidently] due to a couple of outlier control students. Without them, even the post-hoc differences that were found in the upper quartile between intervention control groups would likely disappear.” Coyne: "Don’t accept claims of efficacy/effectiveness based on underpowered randomized trials. Dismiss them. The rule of thumb is reliable to dismiss trials that have less than 35 patients in the smallest group. Over half the time, true moderate sized effects will be missed in such studies, even if they are actually there."
Desmond & Hanich (2010). Used MAPs to measure executive functioning. In their study, 15 sixth grade students received the MAPs intervention 25-45 minutes a week for ten weeks, while 25 sixth grade students received TAU, which in this case meant they stayed in their homeroom class. Students in the intervention group saw increased scores on the Metacognition Index and Global Executive Composite of the BRIEF (which was completed by the teachers), while students in the control group saw these scores slightly decline. Same methodological flaws found in the Flook study.
Huppert & Johnson (2010). Non-randomized controlled trial, 173 14-15-year-old boys from two private schools in Australia. Intervention: MBSR-based curriculum, taught 40 minutes per week for four weeks. Groups: there were 11 regular religious education classes; one of the school’s teachers, who had long practiced mindfulness, taught the mindfulness curriculum to five classes; the school’s regular teachers continued the religious education classes to the other six classes (TAU). Measures: Self-report questionnaires, including mindfulness scale (CAMS-R), resilience (Ego-Resiliency Scale, ERS), well-being (Warwick-Edinburgh Mental Well-Being Scale, WEMWBS), and personality (Big Five Personality Dimensions). Results: No differences between the two groups at posttest, BUT those in the intervention group who practiced outside of school were had significantly higher scores on the mindfulness and well-being measures.
Johnson, Burke, Brinkman, & Wade (2016). Classes randomly assigned in Australian primary/secondary schools, average age 13.6. Intervention based on MBSR and MBCT. 8 sessions, 35-60 minutes. Classes taught by outside mindfulness teacher. Control classes: school as usual (TAU). Intervention group 115, control group 154. Several outcome measures: depression, anxiety, wellbeing, eating disorder risk factors, emotional dysregulation, self-compassion and mindfulness. Results: “Unlike earlier promising studies in secondary schools (Atkinson & Wade, 2015; Kuyken et al., 2013; Raes et al., 2014; Sibinga et al., 2013), we found no improvements in any of the outcome variables either immediately post intervention or at three-month follow-up, despite high acceptability of the program amongst students and teachers. In contrast, self-rated anxiety was higher in the mindfulness group at follow-up across a range of subgroups: males, and those of both genders with low baseline levels of weight/shape concerns or depression.” // Comment: “Given the exponential growth of studies supporting mindfulness in young people, it is sobering to find that under tightly controlled experimental conditions we were unable to replicate the postulated improvements in mental health. One explanation for a lack of effect is that while mindfulness programs for youth are downward derivations of adult curricula, underlying mechanisms of change may differ between these two populations given incomplete neurocognitive development in the maturing brain (Meiklejohn et al., 2012; Tan, 2015).”
Mai (2010). RCT, low-SES adolescents. The treatment group consisted of just seven students, while the control group consisted of five students. According to the study’s abstract, “[q]ualitative data indicated that study participants both enjoyed and benefited from the mindfulness program, particularly in terms of emotion regulation,” while "[q]uantitative findings showed no evidence of differential group change over time on any of the measures.”
Mendelson et al. (2010). RCT, 97 (mostly African American) fourth and fifth grade students in two Baltimore public schools. The treatment group received 12 45-minute sessions during “resource time,” a period during the school day in which students were allowed to engage in non-academic activities (TAU), while the control group continued to engage in their normal resource time activities. Treatment consisted of yoga, mindfulness, and teaching. At pretest and posttest students were given the following measures: the Involuntary Engagement Coping Scale, which consists of subscales assessing Rumination, Intrusive Thoughts, Emotional Arousal, Physiological Arousal, and Impulsive Action; the Responses to Stress Questionnaire (RSQ) to assess their involuntary responses to stress; the Short Mood and Feelings Questionnaire - Child Version (SMFQ-C) to assess depressive symptoms; the Emotion Profile Inventory (EP) to assess positive and negative emotions; and People in My Life (PIML) to assess relations with others. Compared to students in the control group, students in the treatment group showed significant improvement on only the Involuntary Engagement Coping Scaling, showing significant improvements on the overall scale as well as the Rumination, Intrusive Thoughts, and Emotional Arousal subscales.
Metz et al. (2013). This was not a randomized controlled trial, “pilot study.” 216 high school students. One of the school’s teacher, who received an 8-week MBSR training, taught the class. Treatment group was 18 sessions over 16 weeks, 15-25 minutes of mindfulness per session, followed by regular choir class. Control group was TAU (choir class). Self-report measures. “Students in the treatment group reported small yet statistically significant reductions in emotional regulation difficulties, psychosomatic complaints, and self-report stress level, while moderately increasing self-regulation efficacy of emotions compared to their counterparts.”
Potek (2012). RCT, 30 high school students. The intervention group (N = 16) was taught Learning to Breathe, while the control group was waitlisted. At posttest the intervention group was found to have a significant decrease in anxiety, according to a self-report measure (Multidimensional Anxiety Scale for Children).
Sibinga, Webb, Ghazarian, & Ellen (2016). RCT, 300 middle school students. The students were low-income, mostly African American students who attended a public school in Baltimore. For 12 weeks the treatment group received MBSR while the control group received a health education class. Resnick: "Sibinga and her colleagues tried hard to match the instructors for both the health class and the mindfulness class in terms of engagement and skill level. They tried to make the health class engaging and exciting." At posttest the treatment group had “significantly lower levels of somatization, depression, negative affect, negative coping, rumination, self-hostility, and posttraumatic symptom severity” than the control group. Only abstract available. I'm assuming these were self-report measures. Perhaps the changes could be explained as placebo effect: the intervention group expected to improve emotionally, while the control group did not.
Vickery & Dorjee (2016). Non-randomized controlled trial, 71 British students, ages 7-9. The first two schools who showed interest in the study were assigned the treatment group (N = 33), the last school to respond was assigned the control group (N = 38). Measure: children completed four questionnaires pretest/posttest/3-month follow-up, teachers/parents completed BRIEF pretest/follow-up. Intervention: Paws program taught by teacher during Personal and Social Education (PSE) class, 8 weeks, mindfulness practices in class for 5-10 min a week b/t posttest and follow-up. Teacher received mindfulness training and six months later assessed to ensure that they “had developed sufficient personal mindfulness practice.” Control group: TAU, regular PSE class. Results: Self-report measures for intervention group only improved in one area, negative affect. Teacher BRIEF scores improved, parent BRIEF scores worsened (but I don't think significantly). Teacher BRIEF scores = third party placebo effect?
White (2012). RCT, nonclinical population of fourth-fifth grade girls (N = 155). The intervention consisted of the Mindful Awareness for Girls through Yoga program, which is based on the principles of MBSR. The group was one hour a week for six weeks. The control group was simply waitlisted. While both groups of girls reported similar levels of stress pretest, the girls in the mindfulness group reported higher levels of stress posttest. The intervention group also reported that they were more likely to use coping skills posttest. “Both groups reported significantly greater self-esteem and self-regulation over time.” White wrote that perhaps “this increased awareness of stress actually precipitated more stress.” She further wondered if “[t]he nature of childhood stress may be one of uncontrollability, and the increased awareness of the situation without the necessary cognitive and emotional ability or social support to manage the encounter may increase one’s stress.” She noted that among adults symptoms of depression temporarily increased during mindfulness training but later decreased.
Maynard BR, Solis MR, Miller VL, Brendel KE. (2017) Mindfulness-based interventions for improving cognition, academic achievement, behavior, and socioemotional functioning of primary and secondary school students (PDF). Campbell Systematic Reviews 2017:5 DOI: 10.4073/csr2017.5
Methodologically Indeterminate Studies (only abstracts available)
Raes, Griffith, Van der Gucht, & Williams (2014): “Our objective was to conduct the first randomized controlled trial of the efficacy of a group mindfulness program aimed at reducing and preventing depression in an adolescent school-based population. For each of 12 pairs of parallel classes with students (age range 13–20) from five schools (N = 408), one class was randomly assigned to the mindfulness condition and one class to the control condition. Students in the mindfulness group completed depression assessments (the Depression Anxiety Stress Scales) prior to and immediately following the intervention and 6 months after the intervention. Control students completed the questionnaire at the same times as those in the mindfulness group. Hierarchical linear modeling showed that the mindfulness intervention showed significantly greater reductions (and greater clinically significant change) in depression compared with the control group at the 6-month follow-up. Cohen's d was medium sized (>.30) for both the pre-to-post and pre-to-follow-up effect for depressive symptoms in the mindfulness condition. The findings suggest that school-based mindfulness programs can help to reduce and prevent depression in adolescents.”
Broderick & Metz (2009). RCT, high school girls from private school, Learning to BREATHE. Intervention group: 17 high school seniors. Control group: 30 high school juniors. Intervention: 5 weeks, 2X week, 32-43 minutes each. Assessments: pretest/posttest self-report measures (Positive and Negative Affect Schedule, Difficulties in Emotion Regulation Scale, Ruminative Response Scale, Somatization Index of the Child Behavior Checklist). Results: “The results of these analyses demonstrate that participants in the Learning to BREATHE program reported reductions in negative affect and increases in feelings of calmness, relaxation and self-acceptance compared to controls. There was also an increase among program participants in emotion regulation after program completion. Students indicated greater awareness of their feelings as they were being experienced.” Pretty worthless study. (1) Treatment group had just 17 students, (2) control group TAU, (3) treatment group consisted of seniors and control group of juniors, (4) only self-report measures used.
Flook et al. (2010). RCT, diverse group of 64 second/third grade general education students in Los Angeles. Half of the students were placed in a Mindful Awareness Practices (MAPs) group, while the other half were placed in a silent reading group. The MAPs group helped children to increase awareness of self, the environment, and others. Each group met for 30 minutes twice a week for eight weeks. Both teachers and parents completed a Behavior Rating Inventory of Executive Function (BRIEF) for each student at pretest and posttest. Students in the MAPs group who scored in the highest quartile at pretest (meaning they had the poorest executive functioning skills) showed significant improvement at posttest compared to their counterparts in the reading group. No meaningful difference was found between students with lower pretest scores (meaning students with higher executive functioning skills). // This study is extremely flawed. James Coyne enumerates its many problems. For starters, the study is non-blinded, and its measures are all subjective. Second, there wasn’t an active control. Given this, Coyne writes, “There’s a high likelihood of any differences in outcomes being nonspecific and not something active and distinct ingredient of mindfulness training. In any comparison with the students assigned to reading time, students assigned to mindfulness training have the benefit of any active ingredient it might have, as well as any nonspecific, placebo ingredients.” Third, the sample size is small (making the study "underpowered"). Given this, it’s not a complete surprise that “the differences that are limited to the upper quartile are [evidently] due to a couple of outlier control students. Without them, even the post-hoc differences that were found in the upper quartile between intervention control groups would likely disappear.” Coyne: "Don’t accept claims of efficacy/effectiveness based on underpowered randomized trials. Dismiss them. The rule of thumb is reliable to dismiss trials that have less than 35 patients in the smallest group. Over half the time, true moderate sized effects will be missed in such studies, even if they are actually there."
Huppert & Johnson (2010). Non-randomized controlled trial, 173 14-15-year-old boys from two private schools in Australia. Intervention: MBSR-based curriculum, taught 40 minutes per week for four weeks. Groups: there were 11 regular religious education classes; one of the school’s teachers, who had long practiced mindfulness, taught the mindfulness curriculum to five classes; the school’s regular teachers continued the religious education classes to the other six classes (TAU). Measures: Self-report questionnaires, including mindfulness scale (CAMS-R), resilience (Ego-Resiliency Scale, ERS), well-being (Warwick-Edinburgh Mental Well-Being Scale, WEMWBS), and personality (Big Five Personality Dimensions). Results: No differences between the two groups at posttest, BUT those in the intervention group who practiced outside of school were had significantly higher scores on the mindfulness and well-being measures.
Johnson, Burke, Brinkman, & Wade (2016). Classes randomly assigned in Australian primary/secondary schools, average age 13.6. Intervention based on MBSR and MBCT. 8 sessions, 35-60 minutes. Classes taught by outside mindfulness teacher. Control classes: school as usual (TAU). Intervention group 115, control group 154. Several outcome measures: depression, anxiety, wellbeing, eating disorder risk factors, emotional dysregulation, self-compassion and mindfulness. Results: “Unlike earlier promising studies in secondary schools (Atkinson & Wade, 2015; Kuyken et al., 2013; Raes et al., 2014; Sibinga et al., 2013), we found no improvements in any of the outcome variables either immediately post intervention or at three-month follow-up, despite high acceptability of the program amongst students and teachers. In contrast, self-rated anxiety was higher in the mindfulness group at follow-up across a range of subgroups: males, and those of both genders with low baseline levels of weight/shape concerns or depression.” // Comment: “Given the exponential growth of studies supporting mindfulness in young people, it is sobering to find that under tightly controlled experimental conditions we were unable to replicate the postulated improvements in mental health. One explanation for a lack of effect is that while mindfulness programs for youth are downward derivations of adult curricula, underlying mechanisms of change may differ between these two populations given incomplete neurocognitive development in the maturing brain (Meiklejohn et al., 2012; Tan, 2015).”
Mai (2010). RCT, low-SES adolescents. The treatment group consisted of just seven students, while the control group consisted of five students. According to the study’s abstract, “[q]ualitative data indicated that study participants both enjoyed and benefited from the mindfulness program, particularly in terms of emotion regulation,” while "[q]uantitative findings showed no evidence of differential group change over time on any of the measures.”
Mendelson et al. (2010). RCT, 97 (mostly African American) fourth and fifth grade students in two Baltimore public schools. The treatment group received 12 45-minute sessions during “resource time,” a period during the school day in which students were allowed to engage in non-academic activities (TAU), while the control group continued to engage in their normal resource time activities. Treatment consisted of yoga, mindfulness, and teaching. At pretest and posttest students were given the following measures: the Involuntary Engagement Coping Scale, which consists of subscales assessing Rumination, Intrusive Thoughts, Emotional Arousal, Physiological Arousal, and Impulsive Action; the Responses to Stress Questionnaire (RSQ) to assess their involuntary responses to stress; the Short Mood and Feelings Questionnaire - Child Version (SMFQ-C) to assess depressive symptoms; the Emotion Profile Inventory (EP) to assess positive and negative emotions; and People in My Life (PIML) to assess relations with others. Compared to students in the control group, students in the treatment group showed significant improvement on only the Involuntary Engagement Coping Scaling, showing significant improvements on the overall scale as well as the Rumination, Intrusive Thoughts, and Emotional Arousal subscales.
Metz et al. (2013). This was not a randomized controlled trial, “pilot study.” 216 high school students. One of the school’s teacher, who received an 8-week MBSR training, taught the class. Treatment group was 18 sessions over 16 weeks, 15-25 minutes of mindfulness per session, followed by regular choir class. Control group was TAU (choir class). Self-report measures. “Students in the treatment group reported small yet statistically significant reductions in emotional regulation difficulties, psychosomatic complaints, and self-report stress level, while moderately increasing self-regulation efficacy of emotions compared to their counterparts.”
Napoli, Krech, and Holley (2005). RCT, 194 first, second, and third grade general education students. Half of the students were placed in an Attention Academy Program (AAP) group, which involved 12 45-minute sessions over a period of six months. The other students spent this time participating in “reading or other quiet activities.” The goals of AAP were to help students learn to “(1) increase their attention to the present experience, (2) approach each experience without judgment, and (3) view each experience as novel and new.” Each session consisted of “breathing exercises, a body-scan visualization application, a body movement-based task, and a post-session de-briefing or sharing of instructor feedback with the class.” The group was led by two experienced mindfulness teachers. Teachers were given one pretest/posttest measure: the ADD-H Comprehensive Teacher Rating Scale (ACTeRS). Students were given two pretest/posttests measures: the Test of Everyday Attention for Children (TEA-Ch) and the Test Anxiety Scale (TAS). Students in the AAP group showed significant improvement on the TEA-Ch selective attention subscale but not on the sustained attention subscale. Students in the AAP also showed significant improvement on the ACTeRS attention subscale, the ACTeRs social skills subscale, and the Test Anxiety Scale. This study is flawed for reasons described in response to the Flook study (below).
Potek (2012). RCT, 30 high school students. The intervention group (N = 16) was taught Learning to Breathe, while the control group was waitlisted. At posttest the intervention group was found to have a significant decrease in anxiety, according to a self-report measure (Multidimensional Anxiety Scale for Children).
Sibinga, Webb, Ghazarian, & Ellen (2016). RCT, 300 middle school students. The students were low-income, mostly African American students who attended a public school in Baltimore. For 12 weeks the treatment group received MBSR while the control group received a health education class. Resnick: "Sibinga and her colleagues tried hard to match the instructors for both the health class and the mindfulness class in terms of engagement and skill level. They tried to make the health class engaging and exciting." At posttest the treatment group had “significantly lower levels of somatization, depression, negative affect, negative coping, rumination, self-hostility, and posttraumatic symptom severity” than the control group. Only abstract available. I'm assuming these were self-report measures. Perhaps the changes could be explained as placebo effect: the intervention group expected to improve emotionally, while the control group did not.
Vickery & Dorjee (2016). Non-randomized controlled trial, 71 British students, ages 7-9. The first two schools who showed interest in the study were assigned the treatment group (N = 33), the last school to respond was assigned the control group (N = 38). Measure: children completed four questionnaires pretest/posttest/3-month follow-up, teachers/parents completed BRIEF pretest/follow-up. Intervention: Paws program taught by teacher during Personal and Social Education (PSE) class, 8 weeks, mindfulness practices in class for 5-10 min a week b/t posttest and follow-up. Teacher received mindfulness training and six months later assessed to ensure that they “had developed sufficient personal mindfulness practice.” Control group: TAU, regular PSE class. Results: Self-report measures for intervention group only improved in one area, negative affect. Teacher BRIEF scores improved, parent BRIEF scores worsened (but I don't think significantly). Teacher BRIEF scores = third party placebo effect?
White (2012). RCT, nonclinical population of fourth-fifth grade girls (N = 155). The intervention consisted of the Mindful Awareness for Girls through Yoga program, which is based on the principles of MBSR. The group was one hour a week for six weeks. The control group was simply waitlisted. While both groups of girls reported similar levels of stress pretest, the girls in the mindfulness group reported higher levels of stress posttest. The intervention group also reported that they were more likely to use coping skills posttest. “Both groups reported significantly greater self-esteem and self-regulation over time.” White wrote that perhaps “this increased awareness of stress actually precipitated more stress.” She further wondered if “[t]he nature of childhood stress may be one of uncontrollability, and the increased awareness of the situation without the necessary cognitive and emotional ability or social support to manage the encounter may increase one’s stress.” She noted that among adults symptoms of depression temporarily increased during mindfulness training but later decreased.
Maynard BR, Solis MR, Miller VL, Brendel KE. (2017) Mindfulness-based interventions for improving cognition, academic achievement, behavior, and socioemotional functioning of primary and secondary school students (PDF). Campbell Systematic Reviews 2017:5 DOI: 10.4073/csr2017.5
- 44 studies were well designed; in that the researchers assigned children or whole classes to either get MBI or not. Those who didn’t get MBI were put on a waiting list or just continued with their normal school activities.
Raes, Griffith, Van der Gucht, & Williams (2014): “Our objective was to conduct the first randomized controlled trial of the efficacy of a group mindfulness program aimed at reducing and preventing depression in an adolescent school-based population. For each of 12 pairs of parallel classes with students (age range 13–20) from five schools (N = 408), one class was randomly assigned to the mindfulness condition and one class to the control condition. Students in the mindfulness group completed depression assessments (the Depression Anxiety Stress Scales) prior to and immediately following the intervention and 6 months after the intervention. Control students completed the questionnaire at the same times as those in the mindfulness group. Hierarchical linear modeling showed that the mindfulness intervention showed significantly greater reductions (and greater clinically significant change) in depression compared with the control group at the 6-month follow-up. Cohen's d was medium sized (>.30) for both the pre-to-post and pre-to-follow-up effect for depressive symptoms in the mindfulness condition. The findings suggest that school-based mindfulness programs can help to reduce and prevent depression in adolescents.”
* * * * *
Broderick, P. C., & Metz, S. (2009). Learning to BREATHE: A pilot trial of a mindfulness curriculum for adolescents. Advances in school mental health promotion, 2(1), 35-46.
Britton, W. B., Lepp, N. E., Niles, H. F., Rocha, T., Fisher, N. E., & Gold, J. S. (2014). A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children. Journal of School Psychology, 52(3), 263-278.
Carsley, D., Khoury, B., & Heath, N. L. (2018). Effectiveness of Mindfulness Interventions for Mental Health in Schools: a Comprehensive Meta-analysis. Mindfulness, 9(3), 693-707.
Desmond, C. T., Hanich, L., & Millersville, P. A. (2010). The effects of mindful awareness teaching practices on the executive functions of students in an urban, low income middle school. Millersville, PA.
Flook, L., Smalley, S. L., Kitil, M. J., Galla, B. M., Kaiser-Greenland, S., Locke, J., ... & Kasari, C. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of applied school psychology, 26(1), 70-95.
Huppert, F. A., & Johnson, D. M. (2010). A controlled trial of mindfulness training in schools: The importance of practice for an impact on well-being. The Journal of Positive Psychology, 5(4), 264-274.
Johnson, C., Burke, C., Brinkman, S., & Wade, T. (2016). Effectiveness of a school-based mindfulness program for transdiagnostic prevention in young adolescents. Behaviour research and therapy, 81, 1-11.
Mai, R. (2010). Teaching Mindfulness to Low-SES, Urban Adolescents: A Mixed Methods Study of Process and Outcomes. Doctoral dissertation, Available from UMI Dissertation Express (AAT 3426960), New York, NY.
Mendelson, T., Greenberg, M. T., Dariotis, J. K., Gould, L. F., Rhoades, B. L., & Leaf, P. J. (2010). Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. Journal of abnormal child psychology, 38(7), 985-994.
Metz, S. M., Frank, J. L., Reibel, D., Cantrell, T., Sanders, R., & Broderick, P. C. (2013). The effectiveness of the learning to BREATHE program on adolescent emotion regulation. Research in Human Development, 10(3), 252-272.
Napoli, M., Krech, P. R., & Holley, L. C. (2005). Mindfulness training for elementary school students: The attention academy. Journal of applied school psychology, 21(1), 99-125.
Potek, R. (2012). Mindfulness as a school-based prevention program and its effect on adolescent stress, anxiety and emotion regulation. New York University.
Raes, F., Griffith, J. W., Van der Gucht, K., & Williams, J. M. G. (2014). School-based prevention and reduction of depression in adolescents: A cluster-randomized controlled trial of a mindfulness group program. Mindfulness, 5(5), 477-486.
Sibinga, E. M., Webb, L., Ghazarian, S. R., & Ellen, J. M. (2016). School-based mindfulness instruction: An RCT. Pediatrics, 137(1).
Vickery, C. E., & Dorjee, D. (2016). Mindfulness training in primary schools decreases negative affect and increases meta-cognition in children. Frontiers in psychology, 6, 2025.
Waters, L., Barsky, A., Ridd, A., & Allen, K. (2015). Contemplative education: A systematic, evidence-based review of the effect of meditation interventions in schools. Educational Psychology Review, 27(1), 103-134.
White, L. S. (2012). Reducing stress in school-age girls through mindful yoga. J. Pediatr. Health Care 26, 45–56. doi: 10.1016/j.pedhc.2011.01.002
Zenner, C., Herrnleben-Kurz, S., & Walach, H. (2014). Mindfulness-based interventions in schools—a systematic review and meta-analysis. Frontiers in psychology, 5, 603.
* * * * *
Broderick, P. C., & Metz, S. (2009). Learning to BREATHE: A pilot trial of a mindfulness curriculum for adolescents. Advances in school mental health promotion, 2(1), 35-46.
Britton, W. B., Lepp, N. E., Niles, H. F., Rocha, T., Fisher, N. E., & Gold, J. S. (2014). A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children. Journal of School Psychology, 52(3), 263-278.
Carsley, D., Khoury, B., & Heath, N. L. (2018). Effectiveness of Mindfulness Interventions for Mental Health in Schools: a Comprehensive Meta-analysis. Mindfulness, 9(3), 693-707.
Desmond, C. T., Hanich, L., & Millersville, P. A. (2010). The effects of mindful awareness teaching practices on the executive functions of students in an urban, low income middle school. Millersville, PA.
Flook, L., Smalley, S. L., Kitil, M. J., Galla, B. M., Kaiser-Greenland, S., Locke, J., ... & Kasari, C. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of applied school psychology, 26(1), 70-95.
Huppert, F. A., & Johnson, D. M. (2010). A controlled trial of mindfulness training in schools: The importance of practice for an impact on well-being. The Journal of Positive Psychology, 5(4), 264-274.
Johnson, C., Burke, C., Brinkman, S., & Wade, T. (2016). Effectiveness of a school-based mindfulness program for transdiagnostic prevention in young adolescents. Behaviour research and therapy, 81, 1-11.
Mai, R. (2010). Teaching Mindfulness to Low-SES, Urban Adolescents: A Mixed Methods Study of Process and Outcomes. Doctoral dissertation, Available from UMI Dissertation Express (AAT 3426960), New York, NY.
Mendelson, T., Greenberg, M. T., Dariotis, J. K., Gould, L. F., Rhoades, B. L., & Leaf, P. J. (2010). Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. Journal of abnormal child psychology, 38(7), 985-994.
Metz, S. M., Frank, J. L., Reibel, D., Cantrell, T., Sanders, R., & Broderick, P. C. (2013). The effectiveness of the learning to BREATHE program on adolescent emotion regulation. Research in Human Development, 10(3), 252-272.
Napoli, M., Krech, P. R., & Holley, L. C. (2005). Mindfulness training for elementary school students: The attention academy. Journal of applied school psychology, 21(1), 99-125.
Potek, R. (2012). Mindfulness as a school-based prevention program and its effect on adolescent stress, anxiety and emotion regulation. New York University.
Raes, F., Griffith, J. W., Van der Gucht, K., & Williams, J. M. G. (2014). School-based prevention and reduction of depression in adolescents: A cluster-randomized controlled trial of a mindfulness group program. Mindfulness, 5(5), 477-486.
Sibinga, E. M., Webb, L., Ghazarian, S. R., & Ellen, J. M. (2016). School-based mindfulness instruction: An RCT. Pediatrics, 137(1).
Vickery, C. E., & Dorjee, D. (2016). Mindfulness training in primary schools decreases negative affect and increases meta-cognition in children. Frontiers in psychology, 6, 2025.
Waters, L., Barsky, A., Ridd, A., & Allen, K. (2015). Contemplative education: A systematic, evidence-based review of the effect of meditation interventions in schools. Educational Psychology Review, 27(1), 103-134.
White, L. S. (2012). Reducing stress in school-age girls through mindful yoga. J. Pediatr. Health Care 26, 45–56. doi: 10.1016/j.pedhc.2011.01.002
Zenner, C., Herrnleben-Kurz, S., & Walach, H. (2014). Mindfulness-based interventions in schools—a systematic review and meta-analysis. Frontiers in psychology, 5, 603.
Vox Article
Science writer Brian Resnick writes that some studies show that mindfulness has some positive effects in children but notes that the effects seem “to be driven by improvements in the most disadvantaged kids.” He quotes psychologist Harald Walach: “What we see from the data, people who suffer, whether they are kids or whether they are adults, they profit the most. They are at a low point, and from the low point it is always going upward. If you have kids with real emotional problems, you would likely see a larger effect than if you have normal kids who are doing well at school and have a good family background.”
Resnick notes that most mindfulness studies have severe methodological limitations, as it's not clear in these studies if mindfulness is the mechanism of change. The effect we see in some of these studies "could be from just taking time out from the normal classroom schedule, or taking part in a group activity, or being taught by an inspired teacher."
He continues:
Publication bias:
Contraindications:
See also: Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation.
* * * * *
Britton et al. (2014): "However, research of school-based programs also suffers from methodological limitations. First, these programs are often presented as electives (Foret et al., 2012) or as pull-out sessions with a specialist (e.g., a counselor or psychologist). Like other forms of pull-out programs (e.g., social skills programs), the outcomes from such self-selected or elective programs may lack the degree of generalizability available to programs that are undertaken by an entire class or school. [Self-Selection Bias!] Mindfulness-based programs have most often been taught by independent instructors who are hired externally and not delivered by the children’s regular teachers or the school counselor, so there is a lack of evidence suggesting the effectiveness of interventions delivered by class-room teachers during school hours (Fernando & Keller, 2012; Foret et al., 2012; Napoli et al., 2005)."
* * * * *
Non-School-Based
Biegel, G. M., Brown, K. W., Shapiro, S. L., & Schubert, C. M. (2009). Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of consulting and clinical psychology, 77(5), 855.
Biegel, Brown, Shapiro, & Schubert (2009). Participants recruited from outpatient child and adolescent psychiatry program. Adolescent 14-18 years, mostly female, most has been diagnosed with anxiety and mood disorders. Recruited through flyers posted in clinic’s lobby. (Self-selection bias.) MBSR 2 hours a week for 8 weeks, given along with continued psychiatric treatment. Pretest, posttest, 3-month follow-up. “TAU involved individual or group psychotherapy and/or psychotropic medication management at the study site. In accord with usual clinical care at the site, there was considerable variance in TAU received.” So treatment group received MBSR and TAU, while control group just received TAU. Measures: some measures made by the clinic’s clinicians who were unaware of patients’ treatment conditions; other clinic records; self-report measures. Results: According to self-report measures, MBSR members, relative to control group, “showed significant improvements over time in state and trait anxiety, perceived stress, self-esteem, and four of the six indicators of psychopathology assessed—namely, somatic, obsessive–compulsive, interpersonal sensitivity, and depressive symptoms.” “Compared with TAU controls, MBSR participants showed strongly significant improvements over time in GAF score [assessment by clinicians], and the effect size was large.” “At-home mindfulness practice is central to the MBSR program, and our exploratory analyses in the completer sample found that amount of formal practice, particularly number of days of sitting mindfulness practice and average length of each practice session, were related to a number of changes from baseline to follow-up in the clinical or self-report measures assessed in the study.” Limitations: “The present results must be considered specific to the population under study, namely, a heterogeneous population of adolescent psychiatric outpatients, most of who were diagnosed with mood and anxiety disorders.” Also: “Research using one or more active control groups will help to ameliorate concerns about potential confounding effects of differential motivation and attention between the treatment and wait-list control group.”
Resnick notes that most mindfulness studies have severe methodological limitations, as it's not clear in these studies if mindfulness is the mechanism of change. The effect we see in some of these studies "could be from just taking time out from the normal classroom schedule, or taking part in a group activity, or being taught by an inspired teacher."
He continues:
So if you want to see the effectiveness of mediation, you’d compare people who received instruction for a few weeks with those who did not. Right? The problem is that you can’t have the control group do nothing. What if the benefit of being in a mindfulness program is derived from spending time in a classroom setting? Or just paying attention to an instructor?
These variables are really hard to account for, and even the best controlled studies can’t control for expectations or the placebo effect. It’s not like a clinical drug trial where the control and experimental groups are taking an identical-looking pill. In these studies, people know what group they’ve been sorted into. It could be that people who get sorted into mindfulness groups expect greater improvements and are then likely to tell their evaluators they improved.
But even with controls, it’s still hard to control for people’s expectations — it’s impossible to do double-blind studies on mindfulness. And these studies largely rely on participant self-reports in their data collection.
“There's nothing wrong with placebo effects except that they often aren't enduring,” says James Coyne, emeritus professor of psychology in psychiatry at the University of Pennsylvania (and a vociferous critic of psychological research methods).
Publication bias:
A recent PLOS One study found evidence that the whole field of mindfulness studies suffers from publication bias — that is, a tendency for only positive results to be reported, leaving contradictory evidence collecting dust in researchers’ file drawers.
The PLOS authors — McGill University psychologists — did a systematic review of the literature, finding 124 randomized controlled studies on mindfulness. Ninety percent of the studies showed positive results, which is a lot higher than you’d expect given the small sample sizes used in the mindfulness studies. (The percentage of positive results should, according to their calculations, be closer to 65 percent.)
The authors also took a look at mindfulness studies whose methods were registered before the trials began. (Preregistration is now seen as a research best practice, as it limits researchers’ ability to skew conclusions after the data comes in.) They found 21 registered trials, but only eight of these locked-in study designs yielded publishable results. That suggests that many studies that go unregistered and do not find positive results are simply forgotten.
“I’m not against mindfulness,” Brett Thombs, an author of the study, told Nature. “I think that we need to have honestly and completely reported evidence to figure out for whom it works and how much.”
Contraindications:
Though the researchers and studies I consulted agree that it’s basically harmless, I asked Sibinga, the pediatrician, if there are any cases where kids shouldn’t be involved with mindfulness programs. The cases are rare, but she says schizophrenics and people suffering from other thought disorders are not advised to seek out mindfulness training, as it may not be helpful to be “mindful” about thoughts or delusions that don’t have any basis in reality.
The other contraindication is for people who have suffered a severe recent trauma. “Their ability to compartmentalize and wall that [trauma] off is closely related to their ability to cope,” Sibinga says. Mindfulness can be an invitation to tear down those mental walls too soon. And that’s why it’s important, she says, for mindfulness instructors and students to be well trained, and to look out for these vulnerable youth.
See also: Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation.
* * * * *
Britton et al. (2014): "However, research of school-based programs also suffers from methodological limitations. First, these programs are often presented as electives (Foret et al., 2012) or as pull-out sessions with a specialist (e.g., a counselor or psychologist). Like other forms of pull-out programs (e.g., social skills programs), the outcomes from such self-selected or elective programs may lack the degree of generalizability available to programs that are undertaken by an entire class or school. [Self-Selection Bias!] Mindfulness-based programs have most often been taught by independent instructors who are hired externally and not delivered by the children’s regular teachers or the school counselor, so there is a lack of evidence suggesting the effectiveness of interventions delivered by class-room teachers during school hours (Fernando & Keller, 2012; Foret et al., 2012; Napoli et al., 2005)."
* * * * *
Biegel, G. M., Brown, K. W., Shapiro, S. L., & Schubert, C. M. (2009). Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of consulting and clinical psychology, 77(5), 855.
Biegel, Brown, Shapiro, & Schubert (2009). Participants recruited from outpatient child and adolescent psychiatry program. Adolescent 14-18 years, mostly female, most has been diagnosed with anxiety and mood disorders. Recruited through flyers posted in clinic’s lobby. (Self-selection bias.) MBSR 2 hours a week for 8 weeks, given along with continued psychiatric treatment. Pretest, posttest, 3-month follow-up. “TAU involved individual or group psychotherapy and/or psychotropic medication management at the study site. In accord with usual clinical care at the site, there was considerable variance in TAU received.” So treatment group received MBSR and TAU, while control group just received TAU. Measures: some measures made by the clinic’s clinicians who were unaware of patients’ treatment conditions; other clinic records; self-report measures. Results: According to self-report measures, MBSR members, relative to control group, “showed significant improvements over time in state and trait anxiety, perceived stress, self-esteem, and four of the six indicators of psychopathology assessed—namely, somatic, obsessive–compulsive, interpersonal sensitivity, and depressive symptoms.” “Compared with TAU controls, MBSR participants showed strongly significant improvements over time in GAF score [assessment by clinicians], and the effect size was large.” “At-home mindfulness practice is central to the MBSR program, and our exploratory analyses in the completer sample found that amount of formal practice, particularly number of days of sitting mindfulness practice and average length of each practice session, were related to a number of changes from baseline to follow-up in the clinical or self-report measures assessed in the study.” Limitations: “The present results must be considered specific to the population under study, namely, a heterogeneous population of adolescent psychiatric outpatients, most of who were diagnosed with mood and anxiety disorders.” Also: “Research using one or more active control groups will help to ameliorate concerns about potential confounding effects of differential motivation and attention between the treatment and wait-list control group.”
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